Making progress with acne and rosacea

Linda Stein Gold, MD, discussed new therapeutic options available thanks to acne and rosacea research.

The newest advances in acne and rosacea treatments available today and in development were reviewed Saturday during “Acne and Rosacea” (S019).

Acne treatments move ahead

In acne, an oral antibiotic and several promising topical treatments are in phase II and phase III trials, including topicals that could reduce the production of sebum, said Linda Stein Gold, MD. Dr. Stein Gold, director of dermatology clinical research at Henry Ford Health System in Detroit, presented “Topical Therapies: What’s on the Horizon.”

“There is a lot of active research in acne. There are a lot of exciting new developments. We have in the pipeline some new molecules that will enhance our therapeutic options,” she said in an interview about her presentation.

The one oral treatment, sarecycline, appears to have an enhanced anti-inflammatory property in a narrow spectrum of action. It is a member of the tetracycline family that is used once a day. It is in phase III trials, so preliminary data may soon be available, Dr. Stein Gold said.

Two types of topical minocycline — a gel and a foam — are in clinical trials. The foam showed efficacy in treating comedonal lesions, inflammatory lesions, and total lesions in earlier trials. The 4 percent foam “reached the high hurdle of getting patients to clear/almost clear, or at least a two-grade improvement,” she said. Tests of the minocycline gel are just starting phase II trials.

Internet reports of success in topical treatments reducing sebum production are myths, Dr. Stein Gold said, but three topical agents being studied may be the first to actually reduce sebum production.

First is SB204, a topical nitric oxide releasing agent that targets inflammation and is antimicrobial. Some preliminary studies show it might also reduce sebum production, she said, adding that phase II trials were promising. The first of two
phase III clinical trials met all of the primary endpoints; however, the second trial met only one of three endpoints, for non-inflammatory lesions.

Second is DRM01, a novel molecule that targets coenzyme-A carboxylase, a key enzyme in sebum production. It has shown statistically significant improvement in a phase II trial, Dr. Stein Gold said.

Third is cortexolone 17α-propionate 1% cream, a topical anti-androgen which is in phase III clinical trials.

“I think we are going to have the benefit of some new molecules in the near future. It is an exciting time for the treatment of acne,” Dr. Stein Gold said.

Rosacea: Combination therapy

Zoe Draelos, MD, a consulting professor of dermatology at Duke University School of Medicine, presented “State of the Art Treatment Options for Rosacea.”

“Combination therapy is the key to treatment success,” said Dr. Draelos, who discussed a new drug, oxymetazoline, as well as the best approaches for treating erythematotelangiectatic rosacea and inflammatory rosacea.

Oxymetazoline, approved by the Food and Drug Administration in January, is a topical treatment that reduces redness in the face by constricting blood vessels, but it does not cure rosacea. It should be applied every morning.

Other FDA-approved treatments are:

  • Topical ivermectin, which kills Demodex mites on the face, one of the important causative factors of rosacea
  • Two topical antibacterial agents — azelaic acid and metronidazole, which reduce the inflammation that characterizes rosacea
  • Oxymetazoline and brimonidine, which reduce redness
  • Anti-inflammatories, including topical metronidazole, topical azelaic acid, and oral antibiotics

Erythematotelangiectatic rosacea is best treated with topical metronidazole or topical azelaic acid twice a day, Dr. Draelos said. Then, to reduce the redness, topical oxymetazoline or brimonidine should be used every morning to cover the rosacea.

Inflammatory rosacea, which is papulopustular rosacea, features redness, swelling, and acne-like breakouts. “If someone has a lot of inflammatory papules on the face, they might use topical ivermectin at night until the inflammatory papules resolve, and then they would use topical brimonidine or topical oxymetazoline every morning to control the redness,” she said.

After ivermectin is discontinued, topical anti-inflammatories, such as topical metronidazole or topical azelaic acid, can be used, supplemented by ivermectin once a week or once a month, Dr. Draelos said.

Another treatment now in phase III trials is an antimicrobial peptide that is thought to help control bacteria on the skin surface, and it may help in the control of rosacea, she said.

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